Provider Briefing: Magnesium Chloride Supply Challenges in 2026

The intermittent shortage of Magnesium Chloride — particularly the injectable formulation — continues to impact clinical practice in 2026. This article provides a concise, evidence-based overview for physicians, nurse practitioners, physician assistants, and pharmacists managing patients who require magnesium supplementation or repletion.

Whether you're in primary care, cardiology, emergency medicine, or hospital pharmacy, understanding the current supply landscape will help you make informed decisions for your patients.

Shortage Timeline

Here's a brief history of the Magnesium Chloride supply disruption:

• Mid-2023: The FDA first listed injectable Magnesium Chloride (200 mg/mL) on its Drug Shortage Database. Multiple manufacturers, including American Regent and Fresenius Kabi, reported production delays.
• Late 2023 - 2024: The shortage intensified, with hospitals and infusion centers struggling to source adequate supplies. The ASHP Drug Shortage Resource Center flagged Magnesium Chloride injection as a monitored shortage.
• 2025: Partial supply recovery occurred as some manufacturers resumed production, though availability remained inconsistent across regions.
• Early 2026: The injectable shortage persists intermittently. Oral formulations (Slow-Mag, generics) are generally available but face periodic stockouts at the retail level due to elevated consumer demand.

Prescribing Implications

The shortage has several practical implications for clinical practice:

Injectable Magnesium Chloride

• Hospital formularies may need to substitute Magnesium Sulfate injection for Magnesium Chloride injection in many clinical scenarios. Both provide elemental magnesium for IV/IM repletion.
• Dose conversion is necessary: 1 gram of Magnesium Chloride provides approximately 120 mg elemental magnesium, while 1 gram of Magnesium Sulfate provides approximately 100 mg elemental magnesium.
• For emergent indications (torsades de pointes, severe hypomagnesemia, eclampsia), Magnesium Sulfate remains the more widely available and commonly used agent regardless of Magnesium Chloride availability.
• Consider oral repletion pathways when clinically appropriate to reduce demand on injectable supply.

Oral Magnesium Chloride

• When prescribing oral Magnesium Chloride for outpatients, be aware that specific brands (e.g., Slow-Mag) may not be available at all pharmacies.
• Generic delayed-release Magnesium Chloride tablets are generally a suitable and more available substitution.
• Consider specifying "Magnesium Chloride or therapeutically equivalent magnesium salt" to give the pharmacist dispensing flexibility.
• Educate patients that oral Magnesium Chloride supplements are available OTC, so they may not need a prescription to obtain it.

Current Availability Picture

As of February 2026:

• Injectable (200 mg/mL): Intermittently available. Supply varies significantly by region and distributor. Hospital pharmacy departments should check with multiple wholesalers and consider GPO-contracted alternatives.
• Oral delayed-release tablets: Generally available. Brand-name Slow-Mag ($15-$25/60 tablets) and generic equivalents ($8-$15/60 tablets) can be found at most pharmacies and online retailers.
• Oral capsules/liquids: Widely available from supplement manufacturers through pharmacy and retail channels.

Cost and Access Considerations

Understanding the financial landscape helps when counseling patients:

• OTC oral supplements are not covered by most insurance plans, costing patients $8-$25 out of pocket.
• Injectable Magnesium Chloride administered in facility settings is typically covered under medical benefits (not pharmacy benefits).
• There are no manufacturer copay cards or formal patient assistance programs for Magnesium Chloride, given its low cost and OTC availability.
• Patients using FSA/HSA accounts may be able to cover OTC magnesium supplements with a Letter of Medical Necessity from their provider.
• For cost-sensitive patients, Magnesium Oxide ($5-$12/bottle) offers the lowest per-dose cost, though with lower bioavailability.

Tools and Resources for Providers

Several resources can help you manage the shortage and support your patients:

• Medfinder for Providers — Real-time pharmacy availability search tool. Direct patients here to find Magnesium Chloride in stock near them, or use it yourself to identify pharmacies with supply.
• FDA Drug Shortage Database — Monitor the official shortage status of injectable Magnesium Chloride at accessdata.fda.gov.
• ASHP Drug Shortage Resource Center — Clinical guidance and alternative therapy recommendations for magnesium shortages.
• Your hospital P&T committee — Work with pharmacy to establish institutional protocols for magnesium salt substitutions during shortages.

Looking Ahead

Several factors suggest gradual improvement:

• Manufacturers have reported increased production capacity for injectable Magnesium Chloride coming online through 2026.
• The FDA has been working with manufacturers to expedite quality reviews and prevent supply gaps.
• Growing OTC supplement production should continue to stabilize the oral supply chain.

However, providers should continue planning for intermittent injectable shortages through at least mid-2026. Developing institutional protocols for magnesium salt substitution — including dose equivalency tables and formulary alternatives — remains a best practice.

Final Thoughts

The Magnesium Chloride shortage requires proactive management from prescribers and pharmacists. By understanding the supply landscape, having substitution protocols ready, and leveraging tools like Medfinder for Providers, you can minimize disruption to patient care.

For patient-facing guidance you can share, see our article: Magnesium Chloride shortage update for patients. And for help with clinical workflow, read: How to help your patients find Magnesium Chloride in stock.